When Advocacy is a Conflict in Occupational Therapy

You hear about advocacy a lot in occupational therapy these days. Every OT month on social media, OT students and practitioners participating in the ABC’s of OT challenge post “advocacy” for the letter A on the first day. But what exactly is advocacy? How is it defined?


Advocacy appears in the Occupational Therapy Practice Framework 4 and is defined as “efforts directed toward promoting occupational justice and empowering clients to seek and obtain resources to fully participate in their daily life occupations. Efforts undertaken by the practitioner are considered advocacy, and those undertaken by the client are considered self-advocacy and can be promoted and supported by the practitioner”.

So it seems the AOTA has taken on a definition of advocacy for the client. What about advocacy for the profession? Many OTs call for advocacy for the occupational therapy profession as well – to educate the public about what occupational therapists do, the value they bring, etc.

Conflicting Advocacy

Dhillon et. al made some good points about advocacy. It never occurred to me that advocacy can be controversial as there is a potential conflict between advocating for the client and advocating for the profession. To me, this is similar to the triple aim vs. quadruple aim debate. The triple aim is focused on solely the client. Critics of the triple aim recommend that quadruple aim include the providers of care – such as occupational therapists. But the counterargument is that when there are efforts to bring satisfaction to providers, the focus on the client is lost. The same argument could apply to advocating for the client versus/and the profession.

Types of Advocacy

The different types of advocacy described in this article are depicted as a Venn diagram for the client, the OT, and both in the center.

Occupational therapists may advocate for themselves, the client, or both:

  • Personal fulfillment (OT)
  • Power and influence (OT)
  • Engaging in occupation (OT & Client)
  • Client-centered practice (OT & Client)
  • Human rights and basic needs (Client)
  • Quality of life (Client)


Personally, I take an even broader approach to advocacy. Why stop at just the client and the profession? Why not advocate for all in allied health? Do we not advocate for our nurses when the opportunity arises? For support staff when clients take advantage of them for not speaking English? For the ancillary services that are available? While as professionals, our primary goal is to advocate for the client and their families, you can see that advocacy is not so simple and that there are actually conflicts involved. Definitions for advocacy have come from the dictionary, other professions, are directed at the client, some even for the profession. As a start, advocacy should contain both as Dhillon’s model is a good representation that is easy to understand. Maybe it will show up in the OTPF one day.


Dhillon, S. K., Wilkins, S., Law, M. C., Stewart, D. A., & Tremblay, M. (2010). Advocacy in occupational therapy: Exploring clinicians’ reasons and experiences of advocacy. Canadian Journal of Occupational Therapy77(4), 241-248.